I've had a busy 2013 covering health care in Southeast Michigan, and beyond it seems, if you count writing countless articles about the Affordable Care Act and how it affects local companies and people with and without health insurance.

Health care is local, and personal, obviously, but decisions made far away from the home medicine cabinet or physician's office affect people's health and pocketbook in very real ways.

My health care coverage also includes changes and innovations from businesses such as hospitals, physician organizations, insurance companies, nursing homes, mental health providers and post-acute care providers such as home health and rehabilitation companies.

First, here are my top health care stories of the year:

• Obamacare's healthcare.gov marketplace website roll-out fiasco, policy terminations, slow enrollment. Read my news analysis that created quite a controversy. I predict this story will continue well past the time I turn in my private insurance card for a Medicare card.

As possibly my last blog of the year, I offer my take on a variety of completed or still evolving stories. Readers, feel free to add to this list in the comments below.

Medical device profits up, despite 2.3% Obamacare tax

Reading the Dec. 10 Modern Healthcare, it seems the impact to medical device companies from the 2.3 percent tax to help fund the Affordable Care Act was a little overblown.

The article says: "Large multinational companies have so far weathered the additional expense while still earning profits that impress Wall Street."

It is still my belief that the benefits from sales that device makers will enjoy by increasing numbers of people with health insurance will more than offset the $29 billion in additional taxes over 10 years.

However, I also agree with Crain's medical device editorial (in which I had no input) that called for relief from the taxes for the smaller medical device makers and startup companies who could be more affected in the short-run.

As Debbie Wang, an analyst at Morningstar, told our sister publication Modern Healthcare:

"We are seeing an impact, but it's happening at the very, very early stage where venture capital firms are reluctant to invest in development stage companies. Med-tech companies with an idea are having a harder time getting private financing before they go to the capital markets."

Physician payment fix nearly done

After 12 years of kicking the can down the road, Congress appears to be on the verge of ending the annual year-end madness of trying to prevent Medicare physician reimbursements by 24 percent in 2014 and coming up with a permanent solution.

Some physician groups have asked Congress either to find the billions of dollars in budget cuts to pay for the reimbursement increases that doctors have received over the years or just add that amount to the nation's $14 trillion-plus deficit.

But now, Congress finally came up with a plan that many have demanded for years. The solution? Tying physician payment increases to quality. Up to 10 percent of an individual physician's pay could eventually be linked to the doctor's performance on quality indicators.

Another thing that happened that could lead to a solution is the historic slowing of medical inflation that brought down the bill to fix the problem to $116.5 billion over 10 years. The price tag had been as high as $300 billion a couple years ago.

This week, the Senate Finance Committee is expected to vote on a broad bipartisan framework to begin revamping doctors' pay. The House Ways and Means Committee also will vote on a similar bill.

Could it happen? My thought is maybe yes, maybe no. There might be another temporary solution for Jan. 1, but Congressfolks probably will approve this deal early next year.

Congressional budget deal for 2014-15 hits health care providers hard

Per usual, hospitals are bearing the brunt of proposed federal budget cuts.

Under a proposed $85 billion federal budget deal by heavy thinkers U.S. Rep. Paul Ryan and Sen. Patty Murray, the 2 percent Medicare cut targeting hospitals that went into effect last year and runs through 2021 will be extended another two years through 2023.

The cuts of $120 billion from sequestration will now total $142 billion.

"America's hospitals have grave concerns about the Murray-Ryan proposed budget agreement and urge Members of Congress to oppose it," Chip Kahn, president of the Federation of American Hospitals, the for-profit hospital trade group, said in a statement.

"The budget agreement threatens access to critical health care services for seniors by trading off Medicare cuts for increases in government and defense spending today. Rather than providing relief to the arbitrary Medicare sequester cuts, this agreement maintains the current cuts and extends these cuts into the future. It sustains bad budget policy under the guise of solving real mandatory spending issues facing this country."

I expect CFOs of local hospital systems in Southeast Michigan are not that upset about the cuts because they have been budgeting for sequestration, readmission penalties and other payment reductions the past couple of years.

I just wonder if those geniuses in Washington, D.C., who say the federal government needs to reform Medicare to save it for future generations (a good idea) will remember that hospitals have already agreed to shave more than $200 billion from expected payments over the next 12 years.

Healthcare.gov on the mend

While I continue to maintain my disappointment and disgust in how poorly the Obamacare website was rolled out in October, I blogged several times about my own little experiment in enrolling myself and family in Obamacare.

But news the past several weeks has been more positive. Over the past two months, nearly 365,000 Americans have enrolled in a private health insurance plan through 14 state-based exchanges and healthcare.gov, the federal website for 36 states.